Cited by 1,205Treatment of Major DepressionElectroconvulsive Therapy StudiesTryptophan and brain disorders

Antidepressant efficacy of ketamine in treatment-resistant major depression: a two-site randomized controlled trial.

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Murrough, James W., Iosifescu, Dan V., Chang, Lee C., Al Jurdi, Rayan K., Green, Charles E., Perez, Andrew M., Iqbal, Syed, Pillemer, Sarah +4 more·2013·American Journal of Psychiatry

Abstract

OBJECTIVE: Ketamine, a glutamate N-methyl-d-aspartate (NMDA) receptor antagonist, has shown rapid antidepressant effects, but small study groups and inadequate control conditions in prior studies have precluded a definitive conclusion. The authors evaluated the rapid antidepressant efficacy of ketamine in a large group of patients with treatment-resistant major depression. METHOD: This was a two-site, parallel-arm, randomized controlled trial of a single infusion of ketamine compared to an active placebo control condition, the anesthetic midazolam. Patients with treatment-resistant major depression experiencing a major depressive episode were randomly assigned under double-blind conditions to receive a single intravenous infusion of ketamine or midazolam in a 2:1 ratio (N=73). The primary outcome was change in depression severity 24 hours after drug administration, as assessed by the Montgomery-Åsberg Depression Rating Scale (MADRS). RESULTS: The ketamine group had greater improvement in the MADRS score than the midazolam group 24 hours after treatment. After adjustment for baseline scores and site, the MADRS score was lower in the ketamine group than in the midazolam group by 7.95 points (95% confidence interval [CI], 3.20 to 12.71). The likelihood of response at 24 hours was greater with ketamine than with midazolam (odds ratio, 2.18; 95% CI, 1.21 to 4.14), with response rates of 64% and 28%, respectively. CONCLUSIONS: Ketamine demonstrated rapid antidepressant effects in an optimized study design, further supporting NMDA receptor modulation as a novel mechanism for accelerated improvement in severe and chronic forms of depression. More information on response durability and safety is required before implementation in clinical practice.

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Crossref · 10.1176/appi.ajp.2013.13030392

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  • A power analysis based on ketamine's antidepressant effects was used to determine the sample size of 18.

    “A power analysis based on ketamine's antidepressant effects was used to determine the sample size of 18 (Murrough et al, 2013a;Zarate et al, 2006).”

    From Ketamine for Social Anxiety Disorder: A Randomized, Placebo-Controlled Crossover Trial (2018) · cites this paper as Murrough et al, 2013a

    The Statistical Analysis section says the authors used estimated ketamine effects to calculate statistical power, but their planned study group was 72 patients, not 18. The source supports the use of a power analysis, not the attributed sample size. (LLM, conf=0.91)

    Experimental — accuracy not yet measured
  • Ketamine exhibits rapid plasticity-enhancing effects in animal models and rapid clinical effects in human patients.

    “As an example, we discuss the potential for ketamine-which exhibits both rapid plasticity-enhancing effects in animal models 4,10 and rapid clinical effects in human patients 11,12 -to provide a test of the predictions of this integrative model, including simultaneous and correlated reversals of multiple plasticity-related deficits across levels of analysis.”

    From Neuroplasticity in cognitive and psychological mechanisms of depression: an integrative model (2020) · cites this paper as [11]

    Experimental — accuracy not yet measured
  • Ketamine exhibits rapid onset and robust short-term antidepressant effect in patients with treatment-resistant depression.

    “Ketamine, an antagonist of the glutamatergic N-methyl-D-aspartate (NMDA) receptor (an ionotropic glutamate receptor), was shown to exhibit rapid onset and robust, short-term antidepressant effect in patients with treatment-resistant depression (TRD) [1–3].”
  • The lack of efficacy in this trial is likely due to the fact that most patients had mild to moderate depression as opposed to the more severe treatment-resistant major depression studied in ketamine clinical trials.

    “The lack of efficacy in our trial is likely due the fact that in our study most patients had mild to moderate depression as opposed to the more severe treatment-resistant major depression studied in ketamine clinical trials (Murrough et al, 2013a;Murrough et al, 2013b;Zarate et al, 2006).”
  • Subsequent randomized controlled trials replicated a 60-70% response rate of ketamine in treatment-resistant depression populations.

    “Subsequent randomized controlled trials (RCTs) replicated this finding, demonstrating a 60–70% response rate of ketamine in TRD populations.10–14”

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Research works printed but not linked: 1

  1. [16]First MB Spitzer RL Gibbon M Williams JBW Structured Clinical Interview for DSM-IV Axis I Disorders, Patient Edition (SCID-P), version 2 1995 New York New York State Psychiatric Institute, Biometrics Research

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Authors
Murrough, J. W., Iosifescu, D. V., Chang, L. C., Al Jurdi, R. K., Green, C. E., Perez, A. M., Iqbal, S., Pillemer, S., Foulkes, A., Shah, A., Charney, D. S., & Mathew, S. J.
Affiliations
  • Michael E. DeBakey VA Medical Center (US)
  • From the Department of Psychiatry, the Department of Neuroscience, the Department of Anesthesiology, the Department of Pharmacology and Systems Therapeutics, and the Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York; the Department of Anesthesiology and the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston; the Michael E. DeBakey VA Medical Center, Houston; and the Center for Clinical Research and Evidence-Based Medicine, University...
Venue
American Journal of Psychiatry
Published
2013-10
Volume
170
Issue
10
Pages
1134-1142
ISSN
  • 0002-953X (ISSN-L)
  • 1535-7228
OpenAlex
W2128918664
Cited by
1,205
References
39
Citations by year
2026: 48 · 2025: 71 · 2024: 87 · 2023: 92 · 2022: 115 · 2021: 115 · 2020: 118 · 2019: 101 · 2018: 103 · 2017: 81 · 2016: 83 · 2015: 103 · 2014: 76 · 2013: 9 · 2012: 1
FWCI
66.57
Type
journal article
Language
en
Open access
Locations
  • American Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • U.S. Department of Veterans Affairs
  • National Alliance for Research on Schizophrenia and Depression
  • National Institutes of Health (UL1TR000067)
  • National Institute of Mental Health (1K23 MH-094707, R01MH081870, K23MH094707)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
  • Life Sciences › Neuroscience › Biological Psychiatry › Tryptophan and brain disorders
Keywords
ketamine, treatment-resistant depression, major depressive disorder, antidepressant efficacy, NMDA receptor antagonism, glutamate, rapid antidepressant response, intravenous infusion, depression severity
MeSH terms
Adult, Antidepressive Agents, Major Depressive Disorder, Double-Blind Method, Female, Follow-Up Studies, Humans, Infusions, Intravenous, Ketamine, Male, Middle Aged, Personality Inventory, Psychometrics, Excitatory Amino Acid Antagonists, Depressive Disorder, Treatment-Resistant

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